Optimize Your Revenue Cycle
Linda Scott, CPC CPB • March 1, 2021
Optimization of your revenue cycle creates an opportunity to make your practice more manageable and increase your revenue. Although medical billing can be overwhelming, knowing what processes will have the most impact on your practice is vital.
Optimization of your revenue cycle creates an opportunity to make your practice more manageable and increase your revenue. Although medical billing can be overwhelming, knowing what processes will have the most impact on your practice is vital.
Here are a few important tips that will boost your efficiency and will make medical billing easier:
Patient Demographics and Documentation
It's best practice to ask for a patient's insurance card and government-issued ID card during the check-in process. It will enable your practice to capture all required details about patients, e.g., correct name (no spell mistakes), address, contact number, date of birth, marital status, SSN, employer details, and necessary insurance information. Obtaining accurate patient information can save your medical billers a lot of time and decrease the amount of time it takes to receive reimbursement for services.
Eligibility Verification
Eligibility Verification is one of the most important ways you can optimize your revenue cycle. Knowing that the patient’s insurance is valid and their treatment is covered is the first step. If treatment is administered without taking this step, you may never be paid for services rendered.
It is best practice to complete verification before the date of service. This allows the physician's office to confirm insurance coverage and inform the patient of possible cost-share prior to their appointment.
Some insurance companies offer this service online, making it easy to verify coverage, while others require you to call them to get information. Verifying coverage before each patient's visit is not always practical to your staff. At a minimum, you need to be sure to know benefits before the first patient visit and re-validate at the start of the year when most coverage renews. We at Healthy Rev have a streamlined insurance verification process that enables our clients to know whether they will get payment from payers or patients.
Prior Authorization
Prior authorization (PA) is an essential part of the revenue cycle. If the procedures or medication are not pre-authorized by the payer, the claim will rarely be paid. It’s very important that procedures are in place for PA best practices to ensure maximum and timely reimbursement for services. Unsanctioned procedures, incomplete documentation and missing patient information can all result in unapproved PA.
On-time claim submission
Many payers have submission requirements, such as requiring claims to be submitted within a specific time frame, ranging from 30 days to 365 days from the service date. It’s good to file the claim on time to get paid faster. If you fail to file a claim within the time frame, claims will get denied, and your practice will not be reimbursed for the services you provided to the patient. Having a fixed billing schedule for your practice will ensure timely claim filing.
We at Healthy Rev take claim filing as a priority task, and we submit all claims as soon as we validate all the required information.
Medical Coding Audits
Every physician practice should ensure that they provide correct information on claims to save efforts, money, and a lot of hassle correcting denials. It is mandatory to use the correct CPT codes for the services you provided and keep up-to-date on changes to the codes.
Medical coding audits look to the past to improve the future. It is a way to ensure that submitted claims are done with a high degree of accuracy and quality.
This circles back around to coding optimization and denial management. Medical coding audits can help lower overhead by reducing the need for work to be done twice.
Creating a proper process to keep on top of the administrative requirements for error-free revenue cycle will help any practice achieve success.
Healthy Rev offers solutions for the revenue cycle to ensure less overhead and faster reimbursement so you can provide better care to your patients.
Contact Healthy Rev to learn how we can optimize your revenue cycle.
Medical billing is the most critical part of a successful practice and outsourcing helps to enhance net revenue collection. If you are not sure whether you need to outsource medical billing, then following the checklist would be helpful for making an outsourcing decision.